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Updated: May 23, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Frequency of reoperations in patients with Marfan syndrome
Sarah Geisbuesch1, Deborah Schray, Moritz S Bischoff
1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA. sarah.geisbuesch@mountsinai.org
Background:
We undertook a retrospective study of the pattern of reoperations in surgical patients with Marfan disease.
Methods:
Between 1985 and 2008, 83 Marfan patients (60 males, 23 females) underwent 155 aortic operations in our institution. Twenty-eight patients had acute dissection (22 type A, 6 type B), and two had aortic rupture. Mean age at initial operation was 32±13 years. Operations included valve-sparing or Bentall aortic root repair, and ascending aorta, arch, descending thoracic, thoracoabdominal aorta, and infrarenal aortic replacement. Sixty-one patients whose initial operation was elective (Group I) were compared with 22 patients with initial emergency surgery (Group II).
Results:
Overall, 81/83 patients ultimately underwent root/ascending repair: 64% initially and 36% at reoperation. Operative mortality in Group I was 1.6% for both initial operations and reoperations vs 9.0% and 0% in Group II. Significant differences between Group I and Group II patients included: total reoperations (1 vs 3, p=0.05); arch operations (0 vs 1, p=0.003); descending thoracic aortic operations (0 vs 0.5, p=0.003); and total aortic segments replaced (1.6±1.0 vs 2.4±1.1, p=0.001). Survival at 5 and 10 years did not differ between Group I and II patients (87% and 71% vs 82% and 56%, p=0.19).
Conclusions:
Although reoperation occurs in about half of surgical Marfan patients, reoperative mortality is low. Patients with initial elective procedures fare better than those with initial emergency surgery: they have fewer subsequent operations, fewer aortic segments replaced, and trend toward improved survival. Elective root replacement should be seriously considered in any Marfan patient with significant root dilatation.
Insights
Reoperation is common in Marfan syndrome patients undergoing aortic surgery, but mortality is low. Elective initial surgery leads to better outcomes and fewer reoperations compared to emergency procedures.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Aortic Diseases
Background:
- Marfan syndrome is a genetic disorder affecting connective tissue, often leading to aortic complications.
- Surgical intervention is frequently required for aortic root and ascending aorta issues in Marfan patients.
- Reoperations are a significant consideration in the long-term management of these patients.
Purpose of the Study:
- To analyze the patterns and outcomes of reoperations in patients with Marfan syndrome.
- To compare the results of elective versus emergency initial aortic surgeries.
- To identify factors influencing reoperation rates and mortality in this population.
Main Methods:
- Retrospective study of 83 Marfan patients who underwent 155 aortic operations between 1985 and 2008.
- Comparison of outcomes between patients with initial elective surgery (Group I) and emergency surgery (Group II).
- Analysis included reoperation rates, types of aortic procedures, aortic segments replaced, and survival.
Main Results:
- Overall, 81/83 patients required root/ascending aortic repair, with 36% undergoing reoperation.
- Operative mortality was significantly lower for initial elective surgery (1.6%) compared to emergency surgery (9.0%).
- Elective surgery patients had fewer reoperations, fewer aortic segments replaced, and a trend towards improved survival.
Conclusions:
- Reoperation is common in Marfan syndrome patients after aortic surgery, but reoperative mortality is low.
- Initial elective aortic root replacement in Marfan patients is associated with better long-term outcomes.
- Prompt surgical intervention for significant aortic root dilatation in Marfan syndrome is recommended.
